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View ICR - OIRA Conclusion

OMB Control No: 0938-0610	ICR Reference No: 201702-0938-011
Status: Historical Active	Previous ICR Reference No: 201312-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: 21020
Title: (CMS-R-10) Advanced Directives (Medicare and Medicard)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/25/2017
	Date Received in OIRA: 02/27/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved	09/30/2017
Responses	55,039,479	0	55,044,127
Time Burden (Hours)	2,822,749	0	2,836,441
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): PL: Pub.L. 105 - 33 4001 Name of Law: Establishment of Medicare+Choice program.
   PL: Pub.L. 101 - 508 4751 Name of Law: Omnibus Reconciliation Act of 1990
   PL: Pub.L. 105 - 33 4641 Name of Law: Placement of advance directive in medical record.
   PL: Pub.L. 105 - 33 4002 Name of Law: Transitional rules for current medicare HMO program.
   PL: Pub.L. 101 - 508 4206 Name of Law: Omnibus Reconciliation Act of 1990

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	55,039,479	55,044,127	-96	-4,552
Annual Time Burden (Hours)	2,822,749	2,836,441	-6,864	-6,828
Annual Cost Burden (Dollars)	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes to the burden estimates are due to the decrease in the number of participating providers and organizations as a whole.

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Denise King 410 786-1013 Denise.King@cms.hhs.gov

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